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In order to combat low rates of deceased donor donation, Israel has adopted an innovative program that gives potential recipients extra points if they or a relative have agreed to donate an organ. The authors argue the ethical merits and disadvantages of such a system, highlights issues of potential inequalities related to: (a) the number of relatives one might have, (b) the type of living donation one makes, (c) the potential for strategic behavior, and (d) problems regarding the consent of family members.